Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Hepatitis C

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In one line

·Hepatitis C is a virus that spreads through blood and quietly damages the liver over many years.

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Normal physiology

·The liver is a chemical factory in the upper-right belly that cleans toxins from your blood, makes proteins to stop bleeding, stores sugar for energy, and breaks down old red blood cells. Hepatocytes (liver cells) do these jobs around the clock and are built to resist most viruses.

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What goes wrong

·Hepatitis C virus (HCV) sneaks into liver cells through contaminated blood. Once inside, it hijacks the cell's machinery to make thousands of new virus copies. Your immune system sees the infected cells and attacks them, but it can't kill the virus completely. This slow battle destroys liver cells one by one, and the liver tries to patch the damage with scar tissue. Over many years, scar tissue piles up, stiffens the liver (cirrhosis), blocks blood flow, and raises the risk of liver cancer.

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Hallmark signs

·No symptoms at all for years (most common)
·Feeling tired all the time
·Belly pain or feeling full on the right side under the ribs
·Yellow skin and eyes (jaundice)
·Dark urine (tea-colored or cola-colored)
·Itchy skin all over
·Swollen belly (ascites)
·Easy bruising and bleeding

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Red flags · escalate now

·Yellow skin or eyes (jaundice) — the liver may be failing
·Swollen belly that keeps growing — fluid is leaking out because scar tissue is blocking blood flow
·Confusion, strange sleepiness, or trouble waking up — ammonia is poisoning the brain
·Vomiting blood or black tarry stools — a vein in the food pipe has burst because of high pressure from liver scarring
·Easy bruising or bleeding that does not stop — the liver cannot make clotting proteins anymore

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Workup

·Anti-HCV antibody (hepatitis C antibody test)
·HCV RNA (hepatitis C viral load by PCR)
·ALT and AST (alanine aminotransferase and aspartate aminotransferase)
·Hepatitis C genotype test
·FibroScan or liver ultrasound with elastography
·Platelet count
·Albumin and INR (international normalized ratio)
·Abdominal ultrasound with Doppler (if cirrhosis is present)

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Treatment

·Sofosbuvir-velpatasvir or glecaprevir-pibrentasvir (pangenotypic direct-acting antivirals) for 8 to 12 weeks
·Hepatitis A and hepatitis B vaccination
·Ultrasound screening for hepatocellular carcinoma every 6 months (if cirrhosis is present)
·Stop all alcohol use completely and permanently
·Test for HIV and treat with antiretroviral therapy if positive
·Avoid hepatotoxic medications (acetaminophen > 2 grams per day, NSAIDs, certain antibiotics, and supplements)

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NCLEX trap

·Most people with hepatitis C feel completely fine for years, even decades. The virus quietly damages liver cells without causing symptoms because the liver has no pain nerves and can keep working even when hurt. We find hepatitis C with a blood test, not by waiting for someone to feel sick.
·Hepatitis C usually causes zero symptoms. Yellow skin (jaundice) and belly pain only show up late, after decades of scarring have turned the liver hard and bumpy (cirrhosis), or if liver cancer grows. Early hepatitis C is silent — that is why universal screening matters.
·Hepatitis C becomes chronic (stays forever) in about 75 to 85 percent of people who catch it. Without treatment, the virus keeps damaging the liver for life. The new direct-acting antiviral pills cure over 95 percent of cases in 8 to 12 weeks. We treat as soon as we diagnose — no waiting.
·Hepatitis C spreads through any blood-to-blood contact: sharing needles, old blood transfusions before 1992, healthcare needle-stick injuries, tattoos or piercings with unsterilized equipment, and birth to an infected mother. The CDC now recommends screening all adults at least once, regardless of risk factors, because many people do not remember or recognize their exposure.
·Hepatitis C is a slow, chronic infection. Most people have normal liver function for the first 10 to 20 years. Scarring (fibrosis) builds silently; cirrhosis and liver cancer typically take 20 to 30 years to develop if untreated. Early treatment stops progression and prevents these late complications.
·Pan-genotypic direct-acting antiviral combinations — sofosbuvir/velpatasvir (Epclusa) and glecaprevir/pibrentasvir (Mavyret) — work against all six major hepatitis C genotypes. We use the same simple 8- to 12-week pill regimen for nearly everyone, no matter which genotype they carry or whether they have cirrhosis.

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